Pre-op Blood Work

Hi all,

I had blood drawn yesterday in advance of my upcoming RNY this coming Monday (yay!). I've read here that comprehensive blood work for the RNY population will involve 15 or so vials. My doc only ordered 4 vials. No ferritin test - I asked.

So this makes me nervous. I like my surgeon and he has a good reputation here, but developing post-op nutritional deficiencies definitely scares me.

Do you guys have any advice for me? I'm sure insurance won't cover whatever blood tests I would be able to order for myself. However, I want to protect my health, take whatever vitamins I need, and ensure I will remain well as time goes on.

Also, I have been told that all I will need to take vitamin-wise is 4 Bariatric Fusion chewable multi vitamins a day. Is this, in fact, foolishly insufficient?

Thank you,

Cara

The 15 vial tests comes some time after surgery when you're consuming/absorbing much less. Pre-op blood test is pretty standard stuff.

Vitamin/mineral supplements post op seem to vary slightly but I think the big 4 are:

multi vitamins

Calcium with vitamin D

Iron

B-12

Everything is chewable/sub-lingual/transdermal etc

No pills

Thanks Scott, that makes sense! My multi contains 45 mg of iron per day, 560 mcg of B12 per day, no D at all, and 1200 mg of calcium. I am uncertain of whether more of these should be added from the beginning, or if I should wait until I see the results of my first pick-up blood test?

I started taking my supplements within 1 week of having surgery. The first few days is just about getting water and some pills down.

i do believe calcium does does not get absorbed without the help of D3. Most calcium supplements are sold with added D3.

Hi again Scott,

Thanks for responding. I was incorrect: my multis do include 3,000 I.U.s per day. When I was low on Vitamin D, I think I was prescribed 5,000 I.U.s per day, though I could be wrong. I'm not low on D now, as far as I know. I'm going to have to research what potency of these vitamins is recommended for RNY folks, I don't really know much about vitamin and mineral potencies, but I want to do this right. Thanks again.

The lab work they are talking about is for after RNY to see if your absorbing enough. Prior to surgery you wouldn't need 15 vials no matter how careful you or your doctor is being.

Vitamins are between you, your doctor, and possibly your deity. Everyone has an opinion. There are guidelines from the ASMBS. You should do lots of research, listen to your doctor, and then make your best educated choices.

After surgery the types of tests that folks recommend here are beyond what is paid for by most insurance, beyond what is recommended by best practice medical guidelines, and sometimes more than is helpful. Again...it is up to you to decide with your medical team what you feel is reasonable and what you are willing to pay cash for.

Word of caution, often the results are more than a layman can actually interpret and can be used to sell you a whole bunch of 'supplements' that you 'need' which you may not need at all.

For example, I worked for a few years with an elderly man who had paid for lots of lab tests, took those results to his caregiver who was a homeopathy 'adviser' not a doctor, and took all the supplements his adviser told him he needed. Lots of things to help him produce more urine...all well and good since his lab results showed too much creatinine in his blood. The trouble was the guy had a physical blockage not kidney problems. The adviser wasn't a nephrologist and couldn't really understand the lab results. The more supplements he took to help him pee more, the more backed up his kidneys were. By the time he ended up in the hospital his kidneys had failed irreversibly and he spent his last years on dialysis.

You are going to be on a learning adventure as you go through this process. Enjoy the journey and all the best to you!

~Elizabeth

Thank you Elizabeth! I misunderstood the timing of the 15 vials, but that makes sense. I appreciate the ASMBS link. I will do my best to stay on top of this.

The purpose of preop bloodwork is to make sure you are healthy going into surgery, so they don't test for a lot. Iron, red and white cell counts, etc, are important.

The blood tests that come first after surgery are also focused on health and recovery. It's not until at least 6 months to a year that you have to really worry about WLS induced deficiencies.

I would want a few baseline tests, so you have a reference for postop test results. I would have ferritin and D3 checked for sure.

The standard recommendation is 2 multivitamins per day, and 500 mg calcium citrate 3 times per day, all 2 hours apart. And some iron. Most people, but not all, need extra iron, B12, and D3. Amounts vary wildly. I know some who need no D, and others who need 50,000 per day. Some need no iron, some take 200mg per day, and still need infusions.

All you can do is start with the recommended amounts, and have regular labs, making adjustments as you go.

Thank you, Grim, I appreciate your response. I can self-pay and pre-order a ferritin test to have as a baseline - better do it now since surgery is Monday!

Thanks again to everyone.